Gutiérrez-Bautista Álvaro J, Morgaz Juan, Granados María Del Mar, Gómez-Villamandos Rafael J, Dominguez Juan M, Fernandez-Sarmiento José A, Aguilar-García Daniel, Navarrete-Calvo Rocío
Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain.
Anaesthesia Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, University of Córdoba, Córdoba, Spain.
Vet Anaesth Analg. 2018 Nov;45(6):820-830. doi: 10.1016/j.vaa.2018.06.016. Epub 2018 Aug 11.
To evaluate and compare the analgesic efficacy and adverse effects of dexketoprofen and methadone using a noninferiority trial, during the first 24 postoperative hours in dogs undergoing orthopaedic surgery.
Randomized, blinded clinical study.
A total of 38 healthy dogs undergoing orthopaedic surgery.
Dogs were premedicated with dexmedetomidine [1 μg kg intravenously (IV)] followed by dexketoprofen (1 mg kg IV; group DK) or methadone (0.2 mg kg IV; group M). Anaesthesia was induced with propofol and maintained with isoflurane in 60% oxygen. Postoperatively, dexketoprofen was administered every 8 hours (group DK) and methadone every 4 hours (group M). Analgesia was assessed at baseline and at 1, 2, 4, 6, 18 and 24 hours after extubation using a dynamic and interactive visual analogue scale (DIVAS), the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF), mechanical wound thresholds (MWTs) and plasma cortisol levels. If CMPS-SF score was ≥5, rescue analgesia was administered. Data were analysed using a general linear mixed model, Mann-Whitney U test and chi-squared test as appropriate; a p value <0.05 was considered significant.
The CMPS-SF and DIVAS scores were significantly higher in group M compared with group DK and remained higher for a longer period in group M, although the differences were not clinically significant. No significant differences were found in MWT assessment between groups. Plasma cortisol level significantly increased 2 hours after extubation, without significant differences between treatments. Rescue analgesia was administered to three animals (one in group DK; two in group M).
We conclude that 1 mg kg IV dexketoprofen administered every 8 hours during the first 24 hours postoperatively is noninferior to methadone in controlling pain after orthopaedic surgery in dog, although frequent pain assessments are recommended to adjust the analgesia plan.
采用非劣效性试验，评估并比较右酮洛芬和美沙酮对接受骨科手术的犬术后24小时内的镇痛效果及不良反应。
随机、双盲临床研究。
总共38只接受骨科手术的健康犬。
犬只先静脉注射右美托咪定（1 μg/kg），随后分别给予右酮洛芬（1 mg/kg静脉注射；DK组）或美沙酮（(0.2 mg/kg)静脉注射；M组）进行预处理。采用丙泊酚诱导麻醉，并用异氟烷在60%氧气中维持麻醉。术后，DK组每8小时给予一次右酮洛芬，M组每4小时给予一次美沙酮。拔管后在基线以及拔管后第1、2、4、6、18和24小时，使用动态交互式视觉模拟评分法（DIVAS）、格拉斯哥综合疼痛量表简表（CMPS-SF）、机械性伤口阈值（MWT）和血浆皮质醇水平评估镇痛效果。若CMPS-SF评分≥5，则给予解救镇痛。数据采用一般线性混合模型、曼-惠特尼U检验和卡方检验进行分析；(p)值<0.05被认为具有统计学意义。
与DK组相比，M组的CMPS-SF和DIVAS评分显著更高，且M组在较长时间内保持更高水平，尽管差异无临床意义。两组间MWT评估无显著差异。拔管后2小时血浆皮质醇水平显著升高，各治疗组间无显著差异。三只动物接受了解救镇痛（DK组1只；M组2只）。
我们得出结论，术后24小时内每8小时静脉注射1 mg/kg右酮洛芬在控制犬骨科手术后疼痛方面不劣于美沙酮，尽管建议频繁进行疼痛评估以调整镇痛方案。
